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Provider Manual

Your source for commonly asked questions about healthcare coverage, claims procedures, policies and more.

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Provider forms

Access forms for medical and dental providers.

Health Information Network (HIN)

Provides access to patient information including demographics, eligibility and benefits, claims, claim submission, claim correction, claim status, remittance advices, fee schedules, and more.

Learn more about HIN

Coverage policy

Quickly search for coverage information using a keyword, procedure code, policy number or title.

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InterQual® Coverage Policy Guidelines

The InterQual® guidelines are used by our utilization management team to help assess whether a given medical condition and known or represented circumstances of a case support medical service(s) as the most appropriate treatment, or whether the medical condition/circumstances presented could be appropriately addressed with an alternative treatment. Use the self-registration tool at the link to create a login and view the criteria. Individuals without an email address should contact the plan to receive the criteria information via mail.

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BlueCard® program

A program linking providers across the country into a single electronic network for claims processing and reimbursement.

Learn about BlueCard

Value-based programs

Learn more about our value-based care program, which rewards providers for coordinating care and for positive health outcomes.

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Blue Distinction Centers

The Blue Distinction program highlights medical facilities demonstrating expertise in delivering quality healthcare.

View Blue Distinction Centers

Total Care

Total Care recognizes doctors that focus on health care instead of sick care. Total Care is coordinated, patient-focused and, in many cases, more affordable healthcare.

Learn more about Total Care

Prior approval statistics

See our prior approval statistics for each quarter for medical, pharmacy and transplants.

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Network participation guidelines

Access network participation guidelines and policies for credentialing standards.

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Network development reps (NDRs)

Contact one of our medical network representatives with questions or billing issues.

Contact NDRs

Medicare Network Specialists

Contact a dedicated representative with questions or billing issues related to Medicare networks.

Contact a specialist

My BlueLine

Participating providers may call My BlueLine for eligibility, claim status and benefit information for patients.

Contact My BlueLine

Prior Authorization Code Lookup

A tool for providers to check if a procedure code is required for a specific group.

Look up Prior Authorization Codes